百日咳患儿进入重症监护室治疗危险因素分析

Risk factors for ICU admission among children with pertussis

目的探讨百日咳患儿进入重症监护室(ICU)治疗的危险因素,为临床及时诊治、减少重症提供参考。方法回顾性分析广州市妇女儿童医疗中心于2016年1月至2019年12月收治的144例百日咳住院婴幼儿临床资料,按收治病房分为普通组及ICU组。采用单因素Logistic回归分析确定进入ICU治疗的相关因素,并进行多因素Logistic回归分析确定入ICU的独立危险因素。结果144例中普通组106例,ICU组38例;男69例,女75例;中位年龄2月龄,<3月龄的ICU病例32例(84.2%,32/38)。102例患儿未接种白喉-破伤风-百日咳(DTP)疫苗。最常见症状为咳嗽(99.3%),其次是发绀(45.1%)、发热(31.9%)和气促(27.8%)。最常见并发症为肺炎(70.1%),其次是呼吸衰竭(24.3%)、脓毒性休克(10.4%)、胸腔积液(9.7%)和肺动脉高压(9.0%)。实验室检查常见白细胞(WBC)和绝对淋巴细胞计数升高,其中19例WBC>50.0×10^(9)/L。入ICU患儿占26.4%(38/144),总体病死率9.0%,ICU组病死率34.2%。百日咳患儿进入ICU的独立危险因素包括WBC>30.0×10^(9)/L;气促,呼吸>70次/min(≤1岁),>60次/min(>1岁);心率>180次/min(≤1岁),>160次/min(>1岁);发绀和血氧饱和度<0.90。结论重症百日咳患儿主要发生在<3月龄的婴幼儿。WBC>30.0×10^(9)/L;气促,呼吸>70次/min(≤1岁),>60次/min(>1岁);心率>180次/min(≤1岁),>160次/min(>1岁);发绀和血氧饱和度<0.90是百日咳患儿进入ICU治疗的独立危险因素。应关注百日咳患儿以上特征,早期识别重症,尽早进入ICU管理。

Objective To analyse the risk factors for intensive care unit(ICU) admission among children with pertussis, in order to provide timely treatment and reduce the risk of death. Methods The clinical data of 144 child patients with pertussis who were admitted to Guangzhou Women and Children’s Medical Centre between January 2016 and December 2019 were retrospectively studied.Patients were divided into general group and ICU group. The univariate Logistic regression analysis was used to determine the factors related to ICU admission.Multivariate Logistic regression analysis was used to determine the independent risk factor for ICU admission. Results Totally 144 patients were enrolled(general group 106 cases, ICU group 38 cases). Among the 144 patients, there were 69 boys and 75 girls, with the median age being 2 months, and there were 32 patients aged <3 months in ICU group. Totally 102 patients were unvaccinated for diphtheria-tetanus-pertussis(DTP). The most common symptom was cough(99.3%),followed by cyanosis(45.1%),fever(31.9%) and shortness of breath(27.8%).The most common complication was pneumonia(70.1%),followed by respiratory failure(24.3%),septic shock(10.4%),pleural effusion(9.7%),and pulmonary hypertension(9.0%). The most common laboratory findings were increased WBC and absolute lymphocyte count, including 19 cases with WBC>50.0×10~9/L. The rate of ICU admission was 26.4%(38/144),the total mortality of pertussis was 9.0%,and the mortality of ICU group was 34.2%. The independent risk factors for the ICU admission among infants and young children with pertussis were WBC>30.0×10~9/L,shortness of breath, respiratory rate > 70/min(≤1 year old) or>60/min(>1 year old),heart rate>180/min(≤1 years) or>160/min(>1 year old),cyanosis, and oxygen saturation < 0.90. Conclusion Severe pertussis of infant mainly occurred in children aged < 3 months. The presence of WBC>30.0×10~9/L,shortness of breath, respiratory rate > 70/min(≤1 year old) or>60/min(>1 year old),heart rate>180/min(≤1 years) or>160/min(>1 year old),cyanosis, and oxygen saturation < 90% are independent risk factors for ICU admission among children with pertussis. Paediatricians should pay more attention to these symptoms, identify the severe cases in early stage, and transfer the patients to ICU as soon as possible.